Prognostic value of preoperative ¹⁸F-FDG PET/CT for primary head and neck squamous cell carcinoma

¹⁸F-FDG PET/CT is clinically useful in the initial staging and follow-up of patients with head and neck squamous cell carcinoma (HNSCC). We studied the potential prognostic significance of preoperative ¹⁸F-FDG PET/CT in HNSCC. The medical records of 294 patients who underwent preoperative ¹⁸F-FDG PET/CT for HNSCC were retrospectively reviewed. The median SUV_max of the primary lesions (SUV_max-p) and cervical lymph nodes (SUV_max-n) was 7.98 ± 5.04 (range 1.2–28.7) and 3.34 ± 3.70 (range 1.0–20.4), respectively. There was a significant difference between with and without recurrence in SUV_max-p (11.14 ± 5.36 vs. 6.78 ± 4.35, p < 0.001) and SUV_max-n (5.60 ± 4.22 vs. 1.75 ± 1.46, p < 0.001). The cut-off values of SUV_max-p and SUV_max-n in the context of recurrence and cancer-related death were 8.5 and 3.5. The 5-year disease-free survival of patients with SUV_max-p < 8.5 and SUV_max-n < 3.5 was 79 and 79 %, respectively, whereas that of patients with SUV_max-p ≥ 8.5 and SUV_max-n ≥ 3.5 was 39 and 30 %, respectively. Multivariate analysis confirmed the significant association between 5-year disease-free survival and SUV_max-p ≥ 8.5 (hazard ratio (HR) 2.68, p < 0.001) and SUV_max-n ≥ 3.5 (HR 2.29, p = 0.007). Furthermore, SUV_max-p ≥ 8.5 (HR 3.20, p = 0.012) and SUV_max-n ≥ 3.5 (HR 2.14, p < 0.001) were associated with 5-year overall survival. ¹⁸F-FDG PET/CT cut-off values of SUV_max-p ≥ 8.5 or SUV_max-n ≥ 3.5 are associated with a recurrence and survival in HNSCC.